title: [Perioperative anticoagulant therapy in a patient with congenital antithrombin III deficiency undergoing posterior spinal fusion].
abstract: A 22-year-old female was scheduled to undergo posterior thoracolumbar spinal fusion. She had been diagnosed with congenital antithrombin III (AT-III) deficiency by the onset of pulmonary embolism and deep vein thrombosis after the first operation at the age of 18. Thereafter she had taken warfarin, 5 mg daily, until 4 days before the surgery. Preoperatively, we administered AT-III products to regulate AT-III activity. The posterior spinal fusion was performed successfully without surgical complications. Postoperatively, we continued administration of AT-III products to maintain AT-III activity above 75%. We also used low dose unfractionated heparin with AT-III by continuous intravenous infusion. Heparin was administered with dose adjustment to achieve a target activated partial thromboplastin time of 45 to 60 seconds. After the activated partial thromboplastin time was stabilized in the target range, we started warfarin therapy (target international normalized ratio, 1.5 to 2.5) on postoperative day 16 and stopped administration of heparin on postoperative day 19. There was no thrombosis complications during the perioperative period. Good anticoagulant management was achieved in a patient with congenital AT-III deficiency undergoing posterior spinal fusion.
authors.affiliation: Department of Anesthesiology, School of Medicine, Keio University, Tokyo 160-8582.
authors.forename: Kota
authors.initials: K
authors.lastname: Kubo
authors.forename: Eiki
authors.initials: E
authors.lastname: Hatori
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Suhara
authors.forename: Takashige
authors.initials: T
authors.lastname: Yamada
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Katori
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morisaki
authors.forename: Junzo
authors.initials: J
authors.lastname: Takeda
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D020152:Antithrombin III Deficiency / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019990:Perioperative Care; D013123:Spinal Fusion; D055815:Young Adult
chemical_list: D000925:Anticoagulants